Background and aims We evaluated the efficacy of nasal continuous positive airway pressure (nCPAP) treatment following the administration of surfactant using the INSURE (INtubation SURfactant Extubation) approach. We aimed to compare the efficacy of INSURE during nasal CPAP application and post-surfactant mechanical ventilation in extremely low birth weight (ELBW) infants.

Methods A total of 182 ELBW infants with a diagnosis of respiratory distress syndrome admitted to the neonatal intensive care unit during January 2012 and 2014 were restrospectively screened. Of these 74 received INSURE during nasal CPAP application (INSURE-nCPAP group) and 108 received mechanical ventilation following endotracheal surfactant application (MV group). The rate of mortality, intraventricular haemorrhage (IVH), repeat doses of surfactant, pneumothorax, pulmonary haemorrhage, necrotizing enterocolitis (NEC), sepsis, bronco pulmonary dysplasia (BPD) the duration of hospitalisation were compared between the two groups.

Results Infants in the INSURE-nCPAP group had significantly lower rates of IVH and pulmonary haemorrhage (p = 0,02 and 0,01; respectively). The need for mechanical ventilation, VIP, BPD and the rate of mortality was lower in infants in the INSURE- nCPAP group. While there was no significant difference in the rates of bloodstream infection and ROP between the groups; the duration of hospitalisation was shorter in infants in the INSURE-nCPAP group.

Conclusions In the current study we found that the INSURE-nCPAP approach in preterm infants with respiratory distress syndrome was effective. Additionally, we found that the rate of mortality, IVH, pulmonary haemorrhage and BPD was lower in infants treated with INSURE approach.